1841286846 NPI number — VICKY LEE STARNES OT

Table of content: VICKY LEE STARNES OT (NPI 1841286846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841286846 NPI number — VICKY LEE STARNES OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STARNES
Provider First Name:
VICKY
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSS
Provider Other First Name:
VICKY
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1841286846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3002
Provider Second Line Business Mailing Address:
LONGVIEW
Provider Business Mailing Address City Name:
LONGVIEW
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98632-0302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-414-2048
Provider Business Mailing Address Fax Number:
360-575-6749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
852 COMMERCE AVE
Provider Second Line Business Practice Location Address:
LONGVIEW
Provider Business Practice Location Address City Name:
LONGVIEW
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98632-2406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-501-3750
Provider Business Practice Location Address Fax Number:
360-501-3755
Provider Enumeration Date:
09/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT00003638 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 298854 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8943352 . This is a "CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0172655 . This is a "LABOR & IND." identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8364184 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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